An essential hospital package for South Africa : Selection criteria, costs and affordability.

Background

In 1995 the Committee of Enquiry into National Health Insurance (NHI) recommended that formally employed individuals and their employers be required to fund at least a minimum package of hospital cover for workers and their dependants.

This has recently been echoed in a Department of Health policy paper on social health insurance.

This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa.

Criteria for package definition

Based on the objectives implicit in the NHI Committee report, the following criteria were used to define the essential package (i) the extent to which was another appropriate responsible party who should for treatment ; (ii) the degree of discretion in deciding or not to provide treatment (roughly equivalent to'urgency'and (iii) the cost and effectiveness of treatment.

Results

On the basis of the above criteria, 396 out of 598 possible interventions were included in the package.

Using local mine hospital and private sector utilisation rates and mine hospital cost data, it was estimated that the essential inpatient package would cost around R502 per enrolee per year, using 1998 prices, for a working age population and their dependants.

Age-sex standardised outpatient care costs in the mine hospital population studied were estimated at R183 per person per year. (...)